title: AIDS-associated Kaposi sarcoma: outcomes after initiation of antiretroviral therapy at a university-affiliated hospital in urban Zimbabwe.
abstract: OBJECTIVE
  To retrospectively investigate the outcomes of patients with AIDS-associated Kaposi sarcoma (AIDS-KS) after initiation of antiretroviral therapy (ART), under routine practice conditions, at a university-affiliated hospital in urban Zimbabwe.
  
  
  BACKGROUND
  While studies from developed nations have demonstrated excellent outcomes for AIDS-KS patients treated with ART, few studies have examined the outcomes of African AIDS-KS patients after starting therapy.
  
  
  METHODS
  A retrospective cohort of 124 AIDS patients initiating ART under routine practice conditions was studied. Thirty-one patients with AIDS-KS were matched 1:3 to 93 AIDS patients without KS (non-KS). The primary outcome was loss-to-care after initiation of therapy. Multivariate analysis was performed to identify significant predictors of loss-to-care. The percent change in weight at 6 months after starting ART was a secondary outcome. A sub-group analysis evaluated differences in pre-treatment variables between AIDS-KS patients retained-in-care compared to those lost-to-care.
  
  
  RESULTS
  AIDS-KS patients had significantly greater 2-year proportional loss-to-care than matched non-KS AIDS patients (26.4% vs. 9.5%; p = 0.01) after initiation of ART. In multivariate analysis, the presence of KS (p = 0.02) was the only significant predictor of loss-to-care. AIDS-KS patients had significantly less weight gain after starting ART than non-KS AIDS patients (+3.4% vs. +6.4%; p = 0.03). AIDS-KS patients retained-in-care had significantly higher pre-treatment CD4+ lymphocyte counts than AIDS-KS patients lost-to-care (223 vs. 110 cells/mm(3); p = 0.04).
  
  
  CONCLUSIONS
  In this retrospective study, AIDS-KS patients experienced significantly worse outcomes than matched non-KS AIDS patients after initiation of ART. AIDS-KS patients with higher pre-treatment CD4+ lymphocyte counts were more likely to be retained in care.
authors.affiliation: Department of Medicine, Division of Cardiovascular Disease, University of California San Diego Health System, 9444 Medical Center Dr, La Jolla, CA 92107, USA; Department of Medicine, Division of Infectious Diseases, University of Colorado Denver School of Medicine, Denver, Colorado, USA. Electronic address: b4nelson@ucsd.edu.
authors.forename: Bradley C
authors.initials: BC
authors.lastname: Nelson
authors.forename: Margaret Z
authors.initials: MZ
authors.lastname: Borok
authors.forename: Tafadzwa O
authors.initials: TO
authors.lastname: Mhlanga
authors.forename: Azure T
authors.initials: AT
authors.lastname: Makadzange
authors.forename: Thomas B
authors.initials: TB
authors.lastname: Campbell
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D060085:Coinfection / Q000188:drug therapy* / Q000401:mortality / Q000821:virology; D004359:Drug Therapy, Combination; D005260:Female; D015497:HIV-1; D019288:Herpesvirus 8, Human; D006785:Hospitals, University; D006801:Humans; D053208:Kaplan-Meier Estimate; D019259:Lamivudine / Q000008:administration & dosage; D008297:Male; D015999:Multivariate Analysis; D019829:Nevirapine / Q000008:administration & dosage; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012514:Sarcoma, Kaposi / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality; D018119:Stavudine / Q000008:administration & dosage; D016896:Treatment Outcome; D014505:Urban Population; D015030:Zimbabwe
chemical_list: D019380:Anti-HIV Agents; D019259:Lamivudine; D019829:Nevirapine; D018119:Stavudine
keywords: AIDS; Antiretroviral therapy; HIV; Kaposi sarcoma